General/Vascular Session
AB081. SOH24AB_239. A surgically led quality improvement initiative in surgical antibiotic prophylaxis (SAP): a one-year review of practice and change
Katie Giblin1, Gerard Hill1, Sadhbh Gash2, Niall Stevens1, Arnold Hill3, Sinead O’Donnell4
1Department of Postgraduate Studies, Royal College of Surgeons in Ireland, Dublin, Ireland;
2Department of Pharmacy, Beaumont Hospital, Beaumont, Dublin, Ireland;
3Department of Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland;
4Department of Clinical Microbiology, Beaumont Hospital, Beaumont, Dublin, Ireland
Background: Amongst growing concerns of antimicrobial resistance, surgical site infection (SSI) remains one of the most common healthcare associated infections. Sub-optimal use of surgical antibiotic prophylaxis (SAP) is commonly reported. Quality improvement (QI) in this area has been shown to be beneficial, but rarely achieves complete compliance. Notably, most of these initiatives are not led by surgeons themselves.
Methods: A two-year, multi-site, surgically led QI initiative was established in 2022. Baseline levels of compliance with local guidelines with regard four aspects of SAP (indication, agent, timing, and duration) was defined using audit. Change interventions aimed at specific aspects of compliance were trialled. Interventions included: guideline education for prescribers, process changes (editing the sign in/time out sheet) and the development and application of various ‘prescribing nudges’.
Results: A total of 620 patient records were audited over four intervention and change cycles. Pre-intervention compliance with all four aspects of SAP was observed in only 72/303 patients (23.8%). Educational interventions with surgical prescribers led to improved compliance with agent choice [43.0% (71/165) to 65.3% (94/144)]. Education of anaesthetists showed improved timing of administration with 10.8% (14/129) of SAP administered post-incision compared to 18.9% (21/111) pre-intervention. Application of prescribing nudges showed an overall decrease in mean SAP duration from 70.4 to 28.2 hours. Overall compliance with all four categories has improved, thus far, from 23.7% to 39.8%.
Conclusions: Increasing compliance with SAP guidance is a challenge. A multi-faceted, institution specific, surgically led approach grounded in QI methodology shows promise.
Keywords: Audit; multi-site; quality improvement (QI); surgical antibiotic prophylaxis (SAP); surgical site infection (SSI)
Acknowledgments
Funding: None.
Conflicts of Interest: The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
doi: 10.21037/map-24-ab081
Cite this abstract as: Giblin K, Hill G, Gash S, Stevens N, Hill A, O’Donnell S. AB081. SOH24AB_239. A surgically led quality improvement initiative in surgical antibiotic prophylaxis (SAP): a one-year review of practice and change. Mesentery Peritoneum 2024;8:AB081.
